Day Two of “Measuring Advocacy for Policy Change: The Case for Respectful Maternity Care” Technical Meeting

Measuring advocacy for policy change: The case for respectful maternity care, continued today, charging ahead to develop a common understanding of what is meant by advocacy for policy change and how to put advocacy into practice for respectful maternity care. This morning’s session began with a recap of highlights from the previous days agenda. A particularly salient theme throughout is the need for a clear message and a critical analysis of our audience. For whom or what are we advocating? To whom are we promoting our advocacy for policy change? How can we measure progress and achievement along the way, particularly in the complex field of respectful maternity care? Some of these questions were addressed in case studies from the field. Examples from the White Ribbon Alliance, Care Peru, and Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) highlighted various approaches for drafting a sound theory of change, engaging community participants as part of the monitoring of health systems, and interacting directly with health providers to promote behavior change. Many of the themes of this panel discussion touched upon the multifaceted and complex interconnections of patients, providers, health systems, governments and international bodies and the need for accountability across all sectors to ensure quality respectful maternity care. While good intentions are generally found across these sectors, the following quote nicely summarized a salient theme in this discussion: “A bad system will beat a good person every single time” – Edward Deming Keeping that in mind, our challenge is to figure out a way for childbearing women to want and demand more respectful care, for providers to find a way within the constraints of a system to provide that care, for facilities and health systems to create environments that promote and demand respectful care, and for governments and international bodies to set a zero tolerance policy for disrespect and abuse during childbirth. The afternoon was spent in small breakout sessions in which groups developed advocacy strategies for ensuring respectful maternity care (RMC) and preventing disrespect and abuse at the community, regional, national, and global levels. Each group identified key champions, actors to be influenced, and interim measures to track progress on a range of RMC advocacy goals. One point of consensus among groups was the opportunistic nature of good advocacy efforts: From adapting medical curricula to include RMC rights training to changing ethical norms around RMC through health professional associations, there are obvious benefits of “piggybacking” onto existing coalitions, policies, programs, and measurement frameworks to further RMC goals. Two such windows of opportunity for RMC advocacy discussed were the inclusion of RMC-related targets into the upcoming Sustainable Development Goals and the incorporation of RMC indicators into Round 7 of the Demographic and Health Survey (DHS), which is currently being finalized. Several of the RMC policies and programs highlighted in the group discussions, including promotion of birth companions and “one bed per woman” policies, sparked debates about feasibility and possible unintended consequences. The need to incorporate implementation research into any planned RMC interventions was agreed upon as critical to building the evidence base that will guide future advocacy efforts in this field. More broadly, meeting participants concluded that involving implementers in advocacy is key for identifying feasible and acceptable programs and policies that will be most effective in ensuring respectful maternity care and preventing disrespect and abuse of mothers. Presentations and meeting documents are available on the meeting page. A detailed summary of today’s discussion is available on Storify. Follow the conversation on Twitter at #RMCadv.

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